<div id="main_body">

<style>
	.ui-autocomplete 
	{
		max-height: 300px;
		overflow-y: auto;
		overflow-x: hidden;
		padding-right: 20px;
		font-size:12px;
	}
	#main_body td
	{
		font-size:14px;
	}
</style>
<link rel="stylesheet" href="../app_themes/chosen/chosen.css" />

{literal}
<script type="text/javascript" src="../app_themes/jquery/jquery-1.6.2.js"></script>
<script type="text/javascript" src="../app_themes/jquery/ui/jquery.ui.core.js"></script>
<script type="text/javascript" src="../app_themes/jquery/ui/jquery.ui.widget.js"></script>
<script type="text/javascript" src="../app_themes/jquery/ui/jquery.ui.position.js"></script>
<script type="text/javascript" src="../app_themes/jquery/ui/jquery.ui.datepicker.js"></script>
<script type="text/javascript" src="../app_themes/jquery/ui/jquery.ui.autocomplete.js"></script>
<script type="text/javascript" src="../app_themes/chosen/chosen.jquery.js" ></script>

<script type="text/javascript">
$(function()
{
	$("#odate").datepicker
	({
		
	});	
	
	$("#cdate").datepicker
	({
		
	});	
	
	$(".fancy").chosen(); 
	$(".fancy-deselect").chosen({allow_single_deselect:true});					  
});
</script>
{/literal}

<form action="contact.php" method="post">

<h1>Contact Information for Company</h1>

{if $message != ''}<p style="font-weight:bold;color:blue;">{$message}</p>{/if}{if $message == ''}<br />{/if}

<table class="signupForm">
<tr> <td width='100%'><label>Company Name</label></td><td>
	<select name='txt_employer' data-placeholder="Choose a Company..." class="fancy" style="width:300px;" tabindex="4">
          		<option value=""></option> 
                {foreach from=$companylist key=k item=v name='cList'}<option value="{$k}">{$v}</option>
                {/foreach}
            </select>
</td></tr>

<tr> <td><label>First Name</label></td><td><input type="text" name="txt_fname" required="true" size="40%" x-moz-errormessage="Please enter your first name." value=""></td></tr>

<tr><td><label>Last Name</label></td><td><input type="text" name="txt_lname" required="true" size="40%" x-moz-errormessage="Please enter your last name." value="" ></td></tr>

<tr><td>

<label>Phone Number</label></td><td><input type="text" name="txt_phone1" size="40%" required="true" 
        	pattern="{$phoneREX}" x-moz-errormessage="Please enter a valid phone number." value=""></td></tr>

<tr><td>

<label>Fax Number</label></td><td><input type="text" name="txt_fax1" size='40%' value=""></td></tr>

<tr><td>

<label>Email Address</label></td><td><input type="text" name="txt_email1" size="40%" required="true" pattern="{$emailREX}" 
            	x-moz-errormessage="Please enter a valid email address." value=""></td></tr>

</table>
<br /><br />
<input type="submit" name="bt_submit" value="Submit">

<input type="reset" value="Reset">

</form>

</div>